腰麻-硬膜外联合麻醉在80岁以上高危老年患者髋部骨科手术的应用  

The using of CSEA on over 80-year-old patients who evaluated high risk suffering coxa orthopedics surgery

作　　者：裘剑波[1] 张毅[1] 仲琴[1] 罗义骏[1] 赵清振[1] 

机构地区：[1]解放军第113医院麻醉科,浙江宁波315040

出　　处：《中华保健医学杂志》2009年第6期426-428,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的评价重比重罗哌卡因腰麻-硬膜外联合麻醉用于80岁以上高危老年患者髋部骨科手术的安全性和可行性。方法选择美国麻醉医师协会(ASA)对病情估计评分为Ⅲ～Ⅳ级接受髋部骨科手术的老年患者90例,年龄80～94(86±6)岁,随机分为硬膜外(EA)组30例,腰麻-硬膜外联合麻醉(CSEA)组30例,全麻(GA)组30例,分别接受连续硬膜外麻醉、腰麻加硬膜外麻醉和七氟醚-丙泊酚静吸复合全麻,术中输液按8～10ml·kg-1·h-1输注羟乙基淀粉和复方氯化钠注射液(1∶1),出血量>400ml者酌情输入红细胞悬液和血浆,观察EA组和CSEA组局麻药用量、感觉阻滞起效时间、阻滞平面、阻滞完善时间、痛觉恢复时间及改良Bromage评分,同时观察3个组的麻醉效果、镇痛效果、血流动力学、术后恢复及不良反应。结果CSEA组感觉阻滞起效时间、阻滞完善时间明显快于EA组(P<0.05或P<0.01),下肢改良Bromage评分优于EA组(P<0.01);CSEA组和GA组麻醉效果优于EA组(P<0.05),CSEA组和EA组的术后镇痛效果优于GA组,对血流动力学不良影响小于GA组,不良反应少于GA组,术后恢复优于GA组。结论只要控制好麻醉平面,术中严密监护,精心管理,CSEA用于高龄高危患者髋部骨科手术是安全可行的。Objective To evaluate the safety and feasibility of using hyperbaric ropivacaine solution to over 80-year-old patients who were at high risk suffering coxa orthopedics surgery and CSEA. Methods Choose 90 old patients suffering coxa orthopedics surgery who evaluated Ⅲ-Ⅳ grade by ASA. Their ages range from 80 to 94（86±6）. To separate them as EA group, CSEA Group, GA group, Suffering continual EA, CSEA, GA using sevoflurane and propofol separately. Transfusion HEAS and Ringer＇s solution （1：1,8-10 ml· kg^-1·h^-1） , Transfusion RCS and blood plasma when bleed volume over 400 ml. To observe the differences in local anesthetic dosage of EA group and CSEA group. To compare their beginning time,lane,consummation time of block;time of recuperate algesia and ipv-Bromage. Their effect of anaesthesia ,analgesia,haemodynamics;postoperative recovery, and adverse effect were observed. Results In beginning time and consummation time of block in CSEA group is faster than EA Group manifest- ly;ipv-Bromage of CSEA surpass EA（P〈0.05）. In effect of analgesia,EA and CSEA groups are better. In effect on Haemodynamics,GA is exceed;In postoperative recovery and adverse effect of EA and CSEA groups are less. Conclusions In using low dose drugs,controlling plane of ANA, monitoring closely, and good administration, CSEA are safety and feasibility to over 80-year-old patients who were at high risk. Its exact effects can be certained.

关 键 词：麻醉 罗哌卡因 老年患者 髋部骨科手术 

分 类 号：R614[医药卫生—麻醉学]